The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.
BACKGROUND: In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarte...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2007-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC1939734?pdf=render |
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| author | Delphine Hu Stefano M Bertozzi Emmanuela Gakidou Steve Sweet Sue J Goldie |
| author_facet | Delphine Hu Stefano M Bertozzi Emmanuela Gakidou Steve Sweet Sue J Goldie |
| author_sort | Delphine Hu |
| collection | DOAJ |
| description | BACKGROUND: In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met. METHODOLOGY/PRINCIPAL FINDINGS: We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. CONCLUSIONS/SIGNIFICANCE: Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency obstetric care will further reduce maternal deaths and disability. |
| first_indexed | 2024-12-20T19:36:46Z |
| format | Article |
| id | doaj.art-f59355d887fe4206a59a952b4f40c669 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T19:36:46Z |
| publishDate | 2007-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-f59355d887fe4206a59a952b4f40c6692022-12-21T19:28:39ZengPublic Library of Science (PLoS)PLoS ONE1932-62032007-01-0128e75010.1371/journal.pone.0000750The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.Delphine HuStefano M BertozziEmmanuela GakidouSteve SweetSue J GoldieBACKGROUND: In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met. METHODOLOGY/PRINCIPAL FINDINGS: We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. CONCLUSIONS/SIGNIFICANCE: Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency obstetric care will further reduce maternal deaths and disability.http://europepmc.org/articles/PMC1939734?pdf=render |
| spellingShingle | Delphine Hu Stefano M Bertozzi Emmanuela Gakidou Steve Sweet Sue J Goldie The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. PLoS ONE |
| title | The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. |
| title_full | The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. |
| title_fullStr | The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. |
| title_full_unstemmed | The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. |
| title_short | The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. |
| title_sort | costs benefits and cost effectiveness of interventions to reduce maternal morbidity and mortality in mexico |
| url | http://europepmc.org/articles/PMC1939734?pdf=render |
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